Exploring New Zealand Paramedic Attitudes towards Advance Directives: An Ethical Analysis

Abstract

<jats:p>IntroductionAdvance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research paramedic perspectives. When a cardiac arrest occurs in the community, end of life provisions have often not been considered by patients or the patients are unable to communicate their wishes and these are not usually known to the attending paramedic crew. These factors contribute to an ethically complex decision-making environment. Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under uncertainty. This research aims to highlight and explore underlying values present within practice-based decisions.MethodsAn exploratory, interpretive study, using the Values Exchange, a web-based ethical decision-making tool, explored eighteen urban-based New Zealand paramedics’ deliberative perspectives on an ethically controversial end of life scenario.ResultsThematic analysis of participants’ free text responses ascertained the breadth of views on advanced directives, with the emergence of three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice.ConclusionFindings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging aspect of patient care.</jats:p>

Non‐technical skills in paramedicine: A scoping review

“…Seven articles investigated decision‐making in the setting of end of life. Five specifically explored decision making in out‐of‐hospital cardiac arrest (Anderson, Gott, & Slark, 2018a; Anderson, Gott, & Slark, 2018b; Bury et al, 2019; Davey, Lees, & Godbold, 2016; Davey, Lees, Misselbrook, & Godbold, 2017; Leibold, Lassen, Lindenberg, Graf, & Wiese, 2018). One was a conference abstract, two of these studies were qualitative, while the other two used a mixed‐methods approach.…”

“…It was consistent that paramedics who were uncertain on whether to resuscitate were more likely to begin resuscitation than not (Anderson et al, 2018a; Anderson et al, 2018b; Anderson, 2019). Additionally, Davey et al (2016) identified that paramedics looked to the law to help guide their decisions but noted the law did not always guide paramedics to a decision they felt was right.…”

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

“…This was compounded by uncertainty and lack of availability of EoL advance directives and care planning, which hindered their ability to keep patients at home. 44 57 61 65 PHPs faced a range of system-level barriers and poor EoLC coordination between services. 62 66 Informing families of death was also noted as an especially stressful, time-consuming and challenging task.…”

Estratégias para a atuação pré-hospitalar diante de pacientes com doença avançada em final de vida e suas famílias: revisão integrativa

“…Transport home and terminal extubation by emergency medical services: an example of innovation in end-of-life care artigos contemplaram exclusivamente profissionais de saúde (Davey et al, 2016;Ferrand et al, 2006;Hoare et al, 2018;Jouffroy et al, 2017bJouffroy et al, , 2017aKamphausen et al, 2019;Lord et al, 2012;Murphy-Jones & Timmons, 2016;Patterson et al, 2019;Rogers et al, 2015;Stone et al, 2009;Waldrop et al, 2014Waldrop et al, , 2018Waldrop et al, , 2019Waldrop et al, , 2020Wiese et al, 2013;Wieseet al, 2009;Wiese et al, 2011), 13 envolveram pacientes e familiares (Burnod et al, 2012;Carron et al, 2014;Carter et al, 2019;Clemency et al, 2019;Feder et al, 2006;Jabre et al, 2008;Montgomery et al, 2017;Nemiroff et al, 2019;Swetenham et al, 2014;Taghavi et al, 2012;Wiese et al, 2008;Wieseet al, 2009;Wiese et al, 2010) e um não envolveu participantes (Guru et al, 1999).…”

“…Os desafios que os profissionais de saúde enfrentam durante sua atuação profissional, conforme alguns estudos demonstraram, versaram desde a falta de rastreabilidade das informações sobre o histórico de saúde do paciente, em razão da comunicação ineficiente entre os serviços de saúde (Jabre et al, 2008;Murphy-Jones & Timmons, 2016), o conhecimento e treinamento insuficiente em cuidados paliativos e cuidados a pacientes em final de vida (Waldrop et al, 2014) até a falta de documentos de manifestação dos desejos do paciente (diretivas antecipadas) (Taghavi et al, 2012) ou, na sua existência, ausência de respaldo ético, além da exigência de realizar o atendimento de forma rápida (Davey et al, 2016).…”